Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 1;11(1):55.
doi: 10.1186/s13643-022-01915-6.

The environmental risk factors prior to conception associated with placental abruption: an umbrella review

Ensiyeh Jenabi  1 , Zohreh Salimi  2 , Erfan Ayubi  3 , Saeid Bashirian  4 , Amir Mohammad Salehi  5
Affiliations

The environmental risk factors prior to conception associated with placental abruption: an umbrella review

Ensiyeh Jenabi et al. Syst Rev. .

Abstract

Background: The present umbrella review evaluated risk factors prior to conception associated with placental abruption based on meta-analyses and systematic reviews.

Methods: We searched PubMed, Scopus, and Web of Science until June 25, 2021. All meta-analyses that had focused on assessing the risk factors associated with placental abruption were included. We calculated summary effect estimates, 95% CI, heterogeneity I2, 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2).

Results: There was no risk factor in the present umbrella review with the high level of evidence (class I or II). Eight risk factors including maternal asthma (RR 1.29 95% CI 1.14, 1.47), prior cesarean section (RR 1.38, 95% CI 1.35-1.42), cocaine using (RR 4.55, 95% CI 1.78-6.50), endometriosis (OR 1.40, 95% CI 1.12-1.76), chronic hypertension (OR 3.13, 95% CI 2.04-4.80), advanced maternal age (OR 1.44, 95% CI 1.35-1.54), maternal smoking (OR 1.80, 95% CI 1.75-1.85) (RR 1.65, 95% CI 1.51-1.80), and use of assisted reproductive techniques (ART) (OR 1.87, 95% CI 1.70-2.06) were graded as suggestive evidence (class III). The other four risk factors including pre-pregnancy underweight (OR 1.38, 95% CI 1.12-1.70), preeclampsia (OR 1.73, 95% CI 1.47-2.04), uterine leiomyoma (OR 2.63, 95% CI 1.38-3.88), and marijuana use (OR 1.78, 95% CI 1.32-2.40) were graded as risk factors with weak evidence (class IV).

Conclusion: Maternal asthma, prior cesarean section, cocaine use, endometriosis, chronic hypertension, advanced maternal age, maternal smoking, and use of ART, pre-pregnancy underweight, preeclampsia, uterine leiomyoma, and marijuana use were risk factors associated with placental abruption. Although factors associated with placental abruption have been investigated, the current meta-analytic associations cannot disentangle the complex etiology of placental abruption mainly due to their low quality of evidence.

Keywords: Placental abruption; Risk factor; Umbrella review.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the included meta-analyses in umbrella review
Fig. 2
Fig. 2
Summary estimates of meta-analyses of potential environmental risk factors for placental abruption
See this image and copyright information in PMC

References

    1. Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand. 2011;90(2):140–149. doi: 10.1111/j.1600-0412.2010.01030.x. - DOI - PubMed
    1. Arnold DL, Williams MA, Miller RS, Qiu C, Sorensen TK. Iron deficiency anemia, cigarette smoking and risk of abruptio placentale. J Obstet Gynaecol Res. 2009;35(3):446–452. doi: 10.1111/j.1447-0756.2008.00980.x. - DOI - PubMed
    1. Downes KL, Shenassa ED, Grantz KL. Neonatal outcomes associated with placental abruption. Am J Epidemiol. 2017;186(12):1319–1328. doi: 10.1093/aje/kwx202. - DOI - PMC - PubMed
    1. Adane AA, Shepherd CC, Lim FJ, White SW, Farrant BM, Bailey HD. The impact of pre-pregnancy body mass index and gestational weight gain on placental abruption risk: a systematic review and meta-analysis. Arch Gynecol Obstet. 2019;300(5):1201–1210. doi: 10.1007/s00404-019-05320-8. - DOI - PubMed
    1. Klar M, Michels KB. Cesarean section and placental disorders in subsequent pregnancies - a meta-analysis. J Perinat Med. 2014;42(5):571–583. doi: 10.1515/jpm-2013-0199. - DOI - PubMed

Publication types

LinkOut - more resources